It's really frustrating that, in the first two visualizations, whose only difference is that one shows data for women, and the other shows data for men, they chose to use two different color scales. It makes it difficult to compare between the two.

For example, if you weren't paying close attention to the scales, you might easily get the impression that a greater proportion of women than men smoke in France and Chile.

It seems that it's impossible for people to show charts without making mistakes in data presentation. This website is literally for showing data, and I'm not an expert and I still see errors all over.

For instance: Secondhand smoke deaths by age [0]

They show absolute numbers. You can see that for 70+ year olds, the quantity is increasing at 2016 compared to 2010 and 2005. But, how do we know that it is because the rate is increasing, or just because there are more 70+ year olds? If they had shown each age range divided by the total amount of people in the age range, it would have prevented this.

Every time I see absolute numbers in any kind of data visualization, immediately an alarm goes off I start to analyze whether that makes sense or they needed percentages, and many many times they messed up.

Isn't it incredible how much the smoking culture of America has shifted over time? If only the forces who put the anti-smoking effort into motion could come together and work towards making renewable energy, alternative commuting methods, or universal healthcare acceptable ideas in this country.

Over the weekend a friend of mine pointed out that while nicotine use has dropped, cannabis use has heavily increased. As if, the rise on tobacco prices has driven folks to alternative drugs.

I wonder (and if someone on HN knows how, please share) if you were to track use and abuse of pills, stimulants (including things like 5 hour energy), cannabis and other forms of what’s becoming not-so-recreational drug usage — what would we find?

Well at minimum we mostly know that alcohol and tobacco are on the higher level on the "harm" spectrum than other illegal drugs.

My takeaway is American drug usage has been shaped by a lot of socio economic factors that do not have human or societal health ramifications. There needs to be a total, science-backed overhaul of drug policy for this reason.

Smoking is scary on an individual level, not to mention expensive. Those other causes you mentioned aren't interesting if you don't personally need them. It's harder to get someone to make a short term sacrifice for other people's long term gains.

A better analogy would be a potential campaign to reduce obesity. If US could pull off a public fat shaming campaign as successful and the one around tobacco it would be a huge benefit to individual people's quality of life as well as economy as a whole.

I would argue this is already underway. There is a concerted campaign against fast food and sugary drinks. There are all sorts of programs to encourage people to exercise. Big corporations have annual “health screenings” where they fat shame you if your BMI is a point over and you drink alcohol once a week.

The problem is that obesity is a complex problem. Not everyone who is overweight is a lazy person who eats Doritos on the couch wile watching daytime tv and wondering why they’re so overweight.

Smoking was easy: with extremely rare exception, smokers get lung cancer. Period. Smoking is one of the very few personal behaviors that basically guarantees you will get cancer. It also has the side benefit of annoying the living daylights out of people who don’t smoke which creates social pressure against it. It was pretty much a slam dunk.

I hate to say it but generally people are overweight because they eat more than they should. Not much more to it for majority of the overweight population. Exercise is great but lack of it isn’t the obesity drover.

Well, there's a darker side to that as well. Obesity is a problem for low income people - because cheap food is usually terrible for you - high calories, high salt, high fat and easy to eat a lot of. Think of your typical fast food - the amount of calories that can be bought for a few dollars. Same with soft drinks. Shaming people who get large might be one strategy, but we also need to stop the fast food peddlers that make it so easy, cheap, and addictive.

> Well, there's a darker side to that as well. Obesity is a problem for low income people - because cheap food is usually terrible for you - high calories, high salt, high fat and easy to eat a lot of. Think of your typical fast food - the amount of calories that can be bought for a few dollars. Same with soft drinks. Shaming people who get large might be one strategy, but we also need to stop the fast food peddlers that make it so easy, cheap, and addictive.

Possibly...I see it more as a matter of education and at the end of the day personal choice. I suspect that for the price of a basic McDonald's meal you could get enough potatoes/pasta, cheese and frozen peas to feed an entire family.

I concur with your thoughts on the addictive nature of some of the foods. But that is slightly misleading. Generally speaking our bodies enjoy fat, sugar, etc no need to fight it. Again I'd rather focus on empowering (or at least trying to) people to make informed decisions regardless of what's being peddled at them ;-)

Sorry but I don't fully agree on this one - you can cook your own stuff from cheap ingredients, you can eat cheap pre-made salads etc. I had my share of burgers and other crappy food in my life, but it was always my conscious decision over healthier options. blaming some evil forces out there is beyond pathetic

Let's stop treating people who eat what they want as children who don't have the willpower to decide for themselves (or like heroin addicts).

You want a simple solution? Tax food based on sugar content, and tunnel those extra billions into some meaningful part of healthcare system. Make obvious junk food more expensive. Of course this won't happen so easily, but even marginal steps can save hundreds/thousands of lives.

> Let's stop treating people who eat what they want as children who don't have the willpower to decide for themselves (or like heroin addicts).

That's a really negative spin. Think of single parents who work two jobs, and barely have time to sleep. Shopping, planning meals, and cooking all take time. Stopping at MacDs and buying 99cent meals on the way home from work is way easier. Food that's bad for you, especially sugary soft drinks, should be taxed to cost a premium to encourage businesses to make their food healthier.

None of those are bad things (except salt if you have existing health conditions, and even then it may be a lack of potassium rather than an excess of salt). The single worst part of fast food is probably the sugar content. Mostly soda, but it's also added to nearly everything (a fast food bun I had the other day was ridiculously sweet).

Before WWII, the US was primarily an agricultural economy. People worked hard, without much automation, and food was comparatively expensive. IMO lack of physical exertion is a huge part of the problem, if only because of the discipline it builds and the reduced opportunities to snack.

By that rationale, obesity is easy since it causes straightforward issues. Notice how you didn’t discuss the reasons people smoke but you waved away obesity due to complexities in which people become obese.

Obesity hurts society by taxing the healthcare system, and by setting an unhealthy example (mainly by normalizing being fat). Smoking does this, but also directly harms non-smoking individuals via second and third hand (via clothing, carpets, drapes, etc.) smoke. The latter (harm to others) made it a lot easier to change society's views on smoking.

Well, the obviously better analogy is drinking. Just as people in the U.S. once thought smoking was essential to the enjoyment of all kinds of human activity, so now do people think this way about alcohol, to enormous social detriment.

Interestingly, the anti-smoking crowd won by convincing the public that absolutely any amount of smoking is so harmful to yourself and (crucially!) everyone around you that consuming even the smallest amounts is unconscionable. That's obviously untrue, but it's a very successful narrative (so successful that I suspect most of you will bristle at the suggestion that it's not true).

This was crucial because it convinced people that: 1) no, moderation isn't acceptable; and 2) every bit of intake is harming somebody else.

A truthful campaign couldn't have made these two arguments and so wouldn't have been as successful.

Except people have no problem making snide comments to smokers when they are smoking outside of a building, but there’d be all sorts of #meTooImFat outrage if you started tsk-tsking fat people eating ice cream.

However, it really isn’t anyone’s business if I’m fat. You could argue health insurance is a shared risk pool, but under that logic, we’d be giving the government the right to dictate every aspect of your life and I am not willing up to give that freedom. Because why stop there — why not have the government mandate hours of sleep or require morning group exercises or require that you get married (since studies have shown that married people have lower heart disease risks.) It could get absurd, but the moment you let the government control even something small, it just keeps growing until we are quite literally Nazi germany where only “ideal” people are allowed to breed or receive permission to open businesses or get desirable jobs.

I’d rather a fat, free society where you can smoke if you want or drink whisky every night than a “healthy” society where the government literally monitors your every breath.

We talk about digital privacy with almost religious conviction, yet when it comes to things like public health, many are willing to let the government sit down with you at the dinner table.

“Get the government out of the bedroom..” I agree. I also want them out of every other room of my house as well. Government’s role is to provide shared infrastructure that is impractical for private individuals to provide for themselves. Government’s role is to have a legal system where contracts can be enforced. It’s role is also to provide for a common defense: protecting property, protecting us from crime. In short, a government’s job is to protect liberty. It isn’t government’s job to tell people what to consume. We saw Nazi Germany, the Soviet Union, China, Cambodia and now Venenzuela, why the hell would we ever want a government so ubiquitous and powerful that it could descend into such totalitarianism?

I have no problem with government providing for the destitute or providing public goods, but I have a huge problem with the government attempting to regulate the freedom of the individual under the guise that it’s “good” for society. Because “good for society” in Nazi Germany evolved into killing millions of people. It’s all incremental, the march towards a complete Orwellian nightmare. Russians never imagined that Bolshevism would lead to the horrors of the KGB and NKVD. Purges were never expected. Cubans never expected that supporting the revolution would mean millions of them would end up in prison or executed for thought crimes.

As far as “good for the economy” — the US economy got so powerful because of freedom; start messing with that and you could disrupt the very foundation upon which the largest economy in the world was built.

There's a difference between the government telling you (i.e. a real person) what to do on the one hand, and the government telling a corporation (i.e. a system that can neither live nor die, can neither suffer nor experience pleasure) how they can advertise their wares on the other hand.

For instance, Australian adults are free to smoke cigarettes. But companies operating in Australia are not allowed to sell cigarettes without conforming to various restrictions and regulations. Those aren't the same thing.

So the analogy here would be that Coca-Cola is freely allowed to sell their goods, but (a) they're not allowed to advertise them and (b) when they sell them, they should say something like "sugary beverages cause diabetes" (if that's the valid and analogous claim) and show a picture of person with a foot that needs amputating.

If you still want to buy a coke when the bottle looks like a scene from a horror show, you'd be allowed to. But they'd have to give you a reasonable assessment of the consequences of drinking this beverage (which are generally not becoming a hot fit 20 year old on the beach). (Assuming that there is a valid link between regular consumption of sugary beverages and obesity-related health problems - it's not a topic I've specifically investigated but it seems to be the general assumption.)

> It could get absurd, but the moment you let the government control even something small, it just keeps growing until we are quite literally Nazi germany where only “ideal” people are allowed to breed or receive permission to open businesses or get desirable jobs.

You are making a non-sensical slippery slope argument. Heroin has been prohibited for a long time in the US, yet it hasn't turned into Nazi Germany.

> It could get absurd, but the moment you let the government control even something small, it just keeps growing until we are quite literally Nazi germany where only “ideal” people are allowed to breed or receive permission to open businesses or get desirable jobs.

Every government controls more than something small. Very few of them ever turn into Nazi Germany. So, no, I don't think that slippery slope is a useful guideline for evaluating real world questions.

In some areas the percentage of unvaccinated is quite high. See this map of anti-vaxxers by county http://rpubs.com/markdg/AntivaxxerHotspots
It uses the Personal Belief Exemption for school children as a proxy for the general population of anti-vaxxers. So arguably a bit inaccurate.

> It uses the Personal Belief Exemption for school children as a proxy for the general population of anti-vaxxers. So arguably a bit inaccurate.

Well, also there's been a lot of news events around the issue since 2015, which led to the elimination of the exemption, so its quite possible there have been signficant movements in attitudes in the last three years.

State-wide that's true. But herd immunity is a local issue. So if your kid is going to a school where more than 10% of the other kids are unvaccinated then they won't benefit from herd immunity, despite the fact that the number of those unvaccinated kids is a tiny minority of all California kids.

I was also a bit shocked when I saw how high the Personal Belief Exemption was in some counties. Above 5% unvaccinated pretty much destroys herd immunity. So most of northern California is a no-go zone for people who appreciate the value of herd immunity.

I quit the damn thing some 13 years ago and I've never looked back since. Best decision I've ever made. Earned back my life, I'm in my mid forties and my physical endurance is way better than what it was in my twenties. The thing that most smokers don't realize is that smoking is like taking heroin. You're addicted to a substance that's slowly and silently killing you. Just a couple of years ago I lost a very good friend of mine from lung cancer. He was smoking three packs a day and the cancer ended him in less than six months.

To anyone reading this as a smoker. Quit the fucking thing. You won't miss it and there are ways to quit that aren't as harsh as cold turkey. Just seek medical advice and move on.

My dad smoked from he was 16 until around 46 in 2003, when he suffered a (mild) heart attack. He had surgery and a stent put in, and completely quit smoking.

After a short recovery, it was like he was 10 years younger. Previously he would get winded just from tying his shoelaces, a combined effect of the smoking and constricted blood flow.

After recovering, it was like he got a new lease on life, he started getting into cooking healthier food, he started exercising and he even started playing the drums again. He's never been particularly open about his feelings, but I think it was a real eye opener for him, to face his own mortality and realizing that he'd been working way too much and not taking proper care of himself. His own dad died around the same age, also from a heart attack, which also made me realize that I have to watch my cholesterol and exercise more.

My dad turns 61 this October, and he's doing better than ever, fit as a fiddle, goes running and swimming every week. I'm glad he got a relatively mild warning and heeded it, otherwise he probably wouldn't be here today. And I'm glad medical technology had advanced to a point where they could save him, unlike his dad.

I love tobacco. It smells wonderful (no, not cigarettes: tobacco itself, as anyone who's ever smelt pipe smoke will confirm). It tastes delicious (albeit not as good as it smells). It feels wonderful. It even cuts down on appetite, which is a plus in this day and age!

I quit smoking for love, but I miss it every time I think of it. Nonsmokers have no idea what they're missing. It's sheer bliss. The sooner we can figure out how to have noncarcinogenic smoke, the better.

I quit smoking 25 years ago and still miss it. But no regrets, with the horrible smell from breath, clothes and hair, ruined furniture, not to mention adverse health effects, I would still rather go without it.

Is that right that the USA has fewer smokers than New Zealand and Australia?

New Zealand and Australia have made massive efforts to reduce their rates of smokers. They both have plain packaging, tobacco products aren't allowed to be visibly on sale (in New Zealand, they won't even tell you what they have, you have to guess and hope they have it in stock). They also have the most expensive tobacco in the world. A 25 pack of Marlboros will set you back AU$32 (US$23).

That doesn't seem right that the USA, which has in general put a lot less restrictions on tobacco and has much cheaper tobacco, has a lower incidence of smokers than Australia or New Zealand.

Anecdotally, most daily smokers I know aren't smoking 20 a day either.

Going there recently, I was shocked by the mechanical cigarette dispensers by every checkout lane in the supermarket and the large bags of tobacco openly displayed on shelves for sale on the other side of checkout lane.

Contrast that with the UK where tobacco is hidden behind shutters and only available from a separate kiosk area.

I wonder if having it openly displayed at checkouts removes the mystery (and hence its appeal) or just serves to make it an impulse purchase?

I agree - considering that Europeans are generally on a positive track for health related statistics, it always surprises me to see how much more common smoking is there. Even in Sweden which has an image of being a healthy country, I have seen many more people smoking than in the US.

> Very disappointed in EU here! Such a disgusting habit that kills and leads to large quality of life loss later in life
I agree in part but the libertarian in me thinks that people should be free to do what they want to their bodies provided it is not at the expense of society as a whole. For example banning smoking in offices, public buildings, spaces, etc is a good thing. Banning people from smoking in their own garden is not.

> Seeing 15 year olds smoke is a huge societal failure.
Yes and no. General trends suggest they are smoking less and drinking less alcohol compared to previous generations. It probably just stands out more relative to the general population. Alas, youth is lost on the young :-)

People die of something. It costs no matter what that is. So there's some extra cost since they're dying sooner (maybe?) It's more complicated than 'Hospital costs!' since those are pretty unavoidable no matter how you die?

We generally don't shoot people in the head when they've been diagnosed with lung cancer so society doesn't save any money there. So the extensive treatment required to treat lung cancer is greater than somebody not getting treatment because they don't have lung cancer.

To be more succinct, there's a large difference between a person requiring lengthy treatment for lung cancer(hospital + morgue) before ultimately dying compared to somebody dying due to old age(morgue).

While I quit daily smoking years ago I will never give up cigars. Even my doctor has zero issues with that. According to the CDC there is essentially no risk even smoking up to five a day. I am definitely substantially lower than that though.

There are some risks in terms of your mouth/lips. Cigars are a lot less harmful because it's customary not to inhale them, you can obviously but the vast majority of cigar smokers don't. They also appear to be far less addictive than cigarettes, personally I would say they aren't addictive at all, during the winter in the UK I don't smoke any for 3-4 months, during the summer I only smoke a couple a week.

Why on Earth did they shade the percent of men smoking darker than the women? That means in countries where about the same proportion of women as men smoke, which is most countries, the female map is colored as having a higher percentage than men because they made the key identical minus 10%. This makes me irrationally angry.

The worst part is lung diseases often take decades to appear. People who quit smoking after doing it for a few decades may be hit with COPD late in life just when they can least afford it. Compounding other health problems they may already have.

COPD: "Long-term exposure to lung irritants that damage the lungs and the airways usually is the cause of COPD." - nhlbi.nih.gov

I worry about the vaping trend I think there is going to be a massive amount of people diagnosed with COPD in 30 or 40 years.

Always hard to know with science in the news but I thought that there was some good science that showed that even quitting late in life significantly reduced the risk of smoking related illnesses compared to those who did not stop. I thought that was quite interesting that even after say 30 years you could change the odds fairly dramatically.

I've seen that too something like "after an hour your blood pressure returns to normal. After a few days you can breathe easier..."

It's always good to quit but as with genetics people are different. A few rare cases where a person smokes until their 90s and never seems to be affected. But I'd say most people who smoke are not so lucky. Sure maybe in the short term and yes it's great for the ex-smoker and the people around them but late in life illnesses pile up and COPD is a big risk.

My dad smoked but quit around age 30 now he has two lung diseases: COPD and IPF. It's possible one or both are related to his work as an oiler on a ship. He was always around fumes, dust, paint, exhaust but his smoking probably had a lasting effect too.

Japan has no images warning of dangers of anything like that on boxes of cigarettes as far as I can tell (living here for several years) and there is much less a stigma around smoking compared to my home country (Australia).

They can include the brand name in Australia, but the format is precisely specified including valid fonts and sizes. Names are also regulated so they can't imply a health claim (like afaik "Mild").

It would be instructive to do an image search for "Australian cigarette packaging" if you want to see exactly what they look like. I gather a lot of smokers like to use boxes to put their cigarette boxes in so they don't have to see them, but I don't know any smokers so that's just hearsay.

As an Aussie smoker with friends who also smoke, the packaging makes absolutely no difference to us. It was an oddity when it happened, everyone spent time comparing which photos were the most disgusting and now its just background.

Also people buy smokes they like the taste of, the packaging/brand had/has no effect on what people buy.

Yes I think it's funny. Sometimes you'll see a new product on the shelf and then six months or a year later they'll've changed the packaging since the first one didn't work well enough. I guess those must be well funded products owned by big food companies.

And advertising that merely told you they have a product rather than showing unlikely circumstances - or at least had to depict the likely uses of the product. Car ads that sit in traffic rather than zooming through the city. Coke drinkers that struggle to stay awake in the office rather than take a ride in Santa's sleigh in a winter wonderland.

An interesting side effect of plain packaging is that it's made the prevalence of illegally imported cigarettes much more noticeable. There's a fair amount tobacco smuggled in from Indonesia and SE Asia, and you can notice it now because the smuggled packs of smokes still have branding on them.

In Singapore, importing tobacco is illegal full stop (no duty-free or duty-paid allowance) and all legal locally sold tobacco is stamped "SDPC" (Singapore Duty-Paid Cigarette). If you're caught by police with an unstamped cigarette, the first offence fine is $500.

Price per pack or as the chart outlines 25 cigs, seems to be wrong for Canada.

A single pack can cost 11$ CAD to 15.50$ CAD, with cartons costing ~100$ or higher.

Where as in the US you can find 5-8$ pack, and cartons as low as $30$ USD.

The chart shows Canada and USA in the same price/color category.

Canada has been taxing more, and price keeps going up to curb smoking.

Currently trying to implement basic plain packaging.

I would say alot of teens are skipping cigs and straight to vaping.
Where as many adults are quiting cigs or switching to vaping.

I also know of people who increased cannabis use to cut down/stop smoking cigs.

Someone else noted the effectiveness of nicotine... Which is misunderstood.
I am someone who use to smoke a pack a day, to vaping for oral fixation.

My nicotine intake increased with vaping, but the satisfaction was not the same.

The satisfaction in cigs comes from mix in nicotine and increase in carbon monoxide in blood stream mainly.

If anyone is trying to quit, suggest reading: Alan Carr - easy way to quit smoking.
Has helped many people including myself in understanding the sensations and what little control it has over you really.

What's odd about this is that women in "richer" countries smoke more on average than women in developing nations, but conversely, when it comes to men, men in developing nations smoke more on average than men in developed countries...

This could be explained by women in developing nations simply having the least amount of money out of all of these groups and not be able to afford it- otherwise I could imagine women in developing nations would also smoke more than women in developed nations.

There might also be more of a social stigma against women smoking. In the West smoking amongst women was portrayed as dangerous and sexy, while for men it was just part of a hard day’s work. That sort of marketing would translate better for men than for women in more traditional cultures.

I the UK I've always though smoking always thought smoking was slightly more popular with young women. I always put this down to it seeming "cool" or "rebellious" (to them). It also has a reputation as an appetite suppressant which is more women seem to care more about. I literally only know one or two people here in the provinces that smoke, but there were more in London. There were a good few more when I was at university (20 years ago) but most of those carried smokes because they smoked weed too...

A few points about smoking in India:
* Ban on smoking in public places, streets is not strictly followed at all
* Cigarettes are available in every nook and cranny. There is hardly a road side tea shop that doesn't sell cigarettes
* Cigarette sticks can be bought (as against buying a entire pack), more so in road side tea shops

Yeah. I have also often heard westeners saying that "people in China(or Asia) smoke so much!" etc. which is probably true if we are dealing with absolute numbers.
When looking at the relative numbers however, there are more smokers in France than in China and smokers in Sweden consume more cigarettes each day.

I forgot where I heard it but there was a discussion on the radio that indicated that smoking in the US was for a long time was done more by the wealthy... and then the trend shifted to the wealthy quitting and the poor smoking more.

There was also a lot of questions regarding nicotine being used to cope with other issues since nicotine is pretty effective.

One of the few things I despised about traveling in Europe was people smoking inside like it was the 70's. Almost lost it over a couple puffing away in the dairy section of the super market, managed to keep my mouth shut.

Was it in the 70s you went? All European countries now have indoor smoking bans, mostly for a decade or more. Some countries still let you smoke in bars and restaurants, but nowhere allows you to smoke inside a supermarket.

First of all, as other comments have mentioned it's really not a common sight in Europe. Actually, I haven't seen anybody smoking inside a supermarket during my whole life living in Europe (>30 years) and traveling there extensively. Secondly, even if it were common, your indignation seems strange as you come to a different culture and judge people according to your customs. Do you honestly believe that the whole continent should suddenly start behaving differently just because you went traveling there?

Agreed, although my time here in Europe has been much more brief (moved to Berlin in 2017 then Estonia 2018) I've never seen anyone smoking in a supermarket or nearly anywhere else inside in Europe with the exception of Berlin bars which are egregious offenders but I would consider an anomaly in W. EU at least